Provider Demographics
NPI:1669674578
Name:HORNBROOK, THERESA (OTRL)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:HORNBROOK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4673 BRUNNERDALE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2107
Mailing Address - Country:US
Mailing Address - Phone:330-499-3219
Mailing Address - Fax:
Practice Address - Street 1:5425 HIGH MILL AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9005
Practice Address - Country:US
Practice Address - Phone:330-833-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist